(1) Tilt table testing is indicated in the case of unexplained single syncope episode in high risk settings (eg occurrence of, or potential risk of physical injury or with occupational implications), or recurrent episodes in the absence of organic heart disease, or in the presence of organic heart disease, after cardiac causes of syncope have been excluded.

(2) Tilt table testing is indicated when it is of clinical value to demonstrate susceptibility to reflex syncope to the patient.

Class IIa
(1) Tilt testing should be considered to discriminate between reflex and OH syncope.

Class IIb
(1) Tilt testing may be considered for differentiating syncope with jerking movements from epilepsy.

(2) Tilt testing may be indicated for evaluating patients with recurrent unexplained falls.

(3) Tilt testing may be indicated for evaluating patients with frequent syncope and psychiatric disease.

Class III
(1) Tilt testing is not recommended for assessment of treatment.

(2) Isoproterenol tilt testing is contraindicated in patients with ischemic heart disease.

(1) Supine pre-tilt phase of at least 5 minutes, when no venous cannulation, and of at least 20 min, when cannulation is undertaken, is recommended.

(2) Tilt angle between 60-70 degrees is recommended.

(3) Passive phase of a minimum of 20 min and a maximum of 45 min is recommended.

(4) For nitroglycerine, a fixed dose of 300-400 ug sublingually administered in the upright position is recommended.

(5) For isoproterenol, an incremental infusion rate from 1 up to 3 ug/min in order to increase average heart rate by ~ 20-25% over baseline is recommended.

(1) In patients without structural heart disease, the induction of reflex hypotension/Bradycardia with reproduction of syncope or progressive OH
(with or without symptoms) are diagnostic of reflex syncope and OH, respectively.

Class IIa
(1) In patients without structural heart disease the induction of reflex hypotension/Bradycardia without reproduction of syncope may be diagnostic of reflex syncope.

(3) In patients with structural heart disease, arrhythmia or other cardiovascular cause of syncope should be excluded prior to considering positive tilt test results as diagnostic.

(4) Induction of LOC in absence of hypotension and/or Bradycardia should be considered diagnostic of psychogenic pseudosyncope.

European Heart Journal (2009) 30, 2631-2671.